Letter of Medical Necessity

[JimChicago]

In trying to get a home testing INR device - my insurance carrier says they will want a letter of medical necessity signed by a Dcotor. Since I don't imagine I'll find a Doctor who wants to spend time composing a letter on this issue - I was thinking of trying to formulate the basic design of such a form.
I was wondering if anyone has any ideas of such samle letters of medical necessity.
I suppose the points to emphasize are:
1. Mechanicl Heart Valve requiring lifetime INR management due to warfarin treatment.
2. fluctuating INR levels requring frequent testing to avoid strokes and bleeding incidents.
3. I'm only a few miles from a testing site so I can't claim distance.
4. If I were to travel I would need one to test periodically.

Any one have any other ideas?

 

[Ross]

Give QAS a call and ask them how they handle it. Sometimes too much information hurts you more then helps you. I'd find out specifically what they want and not go over that guideline.

 

[QAS]

To Jim

To Jim

Hello,

Please call me, and I can teach you how to present the best possible case to the insurance. Generally you just need a "Certificate of Medical Necessity" and not an entire letter. I have some helpful tips, in your interested.

Lance

 

[LUVMyBirman]

Jim,

My cardioligist absolutly wrote that letter for me. If I am not mistaken....Roche required one.

PS. When traveling by air....if you want to take your unit along...a copy of that letter is a real good idea. Have never been questioned myself...but it can't hurt to be prepared.

Good luck to you!

 

[rcatalano]

Jim, here's what my cardiologist put on the Certificate of Medical Necessity:

- aortic valve replacement
- mechanical heart valve
- long term anticoagulation therapy
- requires frequent testing

The paperwork was submitted a couple of weeks ago, so I haven't heard anything yet. Hopefully, it will be enough justification for an insurance company. But their priorities are a bit different than ours, we'll see.